[A Case Report of the Ascending Colon Cancer with Bullous Pemphigoid].

The patient was a 70-year-old man. The patient had progressive anemia while taking 10 mg/day of prednisolone and 100 mg/day of mizoribine orally for bullous pemphigoid, a colonoscopy diagnosed ascending colon cancer. Adenocarcinoma, Group 5 was detected on biopsy. Abdominal computed tomography showed no metastases. The tumor was diagnosed as ascending colon cancer, cT4aN0M0, cStage Ⅱb. We performed laparoscopic right hemicolectomy and D3 dissection. Histopathological examination revealed pT3N0M0, pStage Ⅱa. In the present report, we describe a case of the ascending colon cancer with bullous pemphigoid, and discuss the case with a review of the literature.

Airway management in a patient with bullous pemphigoid.

Airway management in patients with pemphigoid lesions has anaesthetic implications. We report a case of a 23 years old female with bullous pemphigoid who presented with laryngeal stenosis and critical airway narrowing. The airway was initially managed with jet ventilation. Anaesthesia was maintained with propofol infusion and ventilation was performed by introducing a size 10 French gauge suction catheter through the stenotic laryngeal orifice. Thirty minutes into anaesthesia, she developed subcutaneous emphysema and decreased air entry on right side of the chest but remained hemodynamically stable. The airway was further managed by tracheostomy. This case report highlights complications that can occur during the anaesthetic management of such cases.

Use of a porous polyethylene lid spacer for management of eyelid retraction in patients with Boston type II keratoprosthesis.

PURPOSE: To report a novel application of a porous polyethylene implant for lid stabilization and management of eyelid retraction in a patient with an exposed Boston Keratoprosthesis Type II. METHODS: A 54-year-old woman with a history of mucous membrane pemphigoid and failed penetrating keratoplasty of the left eye underwent implantation of a Boston Keratoprosthesis (KPro) Type II along with permanent surgical fusion of the upper and lower lids of the left eye in January 2010. At one month follow-up, significant retraction of the lower lid around the inferior margin of the optic was noted, resulting in partial exposure of the keratoprosthesis. The patient subsequently underwent left lower eyelid reconstruction with a porous polyethylene implant to ensure coverage and stability of the KPro. RESULTS: Eyelid reconstruction using a porous polyethylene implant resulted in stable retention of the KPro Type II for over 2 years. CONCLUSION: In patients with Boston KPro Type II in the setting of severe cicatrizing ocular surface disease, the use of a porous polyethylene implant during eyelid reconstruction around the KPro optic may aid in maintaining eyelid integrity and improving KPro stability and longevity.

Localized bullous pemphigoid at urostomy site.

Localized bullous pemphigoid occurs in less than one-third of the cases of bullous pemphigoid and it usually appears on the shins. Localized bullous pemphigoid around a stoma site is very uncommon, with few reports in the literature. We report a case of localized bullous pemphigoid at urostomy site and we review its main characteristics. We highlight the importance of considering bullous pemphigoid in chronic bullous lesions on peristomal skin.

[Penetrating keratoplasty in ocular cicatricial pemphigoid]. / La kératoplastie transfixiante dans la pemphigoïde oculaire cicatricielle.

PURPOSE: Ocular cicatricial pemphigoid (OCP) is a chronic progressive disease characterised by exacerbations of immunologically driven conjunctival inflammation. In the advanced stages of the disease, severe xerosis with mechanical factors may contribute to the development of blinding keratopathy. The authors report two cases of penetrating keratoplasty (PK) in patients with OCP and discuss the modalities of the surgical procedure for this particular disease. METHODS: Two patients with stage III OCP according to Foster's classification, underwent PK. Initial and final visual acuity, indications of PK, surgical procedure, postoperative therapy, and complications were recorded. RESULTS: For the first patient, after 3 months of follow-up, the graft is still clear, with a remarkable improvement in vision (3/10). For the second patient, however, graft rejection developed 15 days after the operation, complicated later by endophthalmitis, which was controlled with an antibiotic. DISCUSSION: The progression of ocular pemphigoid involves the filling of the conjunctival fornices, formation of symblepharon with lagophthalmos, and dry eye, from which blinding keratopathy can originate. A corticosteroid-based or immunosuppressant treatment blocks the progression of the fibrosis but does not get rid of palpebrale or corneal anomalies, making surgery necessary. This surgery generally gives disappointing results and should be planned when the disease is perfectly under control, during a lull in the disease so as to avoid reactivation of the fibrosis process. Reconstruction of the conjunctival fornices should also precede any corneal transplantation. CONCLUSION: These results indicate that PK may be performed to restore of sight in patients with advanced OCP after controlling the primary immunological process and aggressive treatment of the mechanical factors damaging the ocular surface.

[Fornix reconstruction in ocular pemphigoid with Goretex surgical membrane]. / Fornixrekonstruktion bei okularem Pemphigoid mit Goretex-surgical-membrane.

UNLABELLED: After separation of symblepharons in ocular pemphigoid, transplantation of nasal or bucal mucosa is recommended to prevent recurrent lid fusion; however, it is not always successful. BACKGROUND: An 86-year-old patient was referred to our eye clinic because of trichiasis in ocular pemphigoid. In the right eye, the only functional eye, fusion of the lower lid and the globe was present. There was severe trichiasis with multiple lesions of the cornea and beginning neovascularization. The left eye showed complete fusion of the lid fissure and neovascularization of the cornea. To prevent the right eye from suffering the fate of the left, we tried to find a simple surgical method that could easily be performed on the multimorbid patient. METHOD: Under parabulbar anesthesia we separated the lower lid from the globe until free passive motility of the lower lid was achieved. A cut-to-size piece of Gore-Tex surgical membrane was prepared and fixated with resorbable u-sutures on the inner lid. The membrane was left in place for 4 weeks until suture lysis. A silicone tube, which was transitorily fixed to the outer lower lid, had an additional ectropionizing effect. Three months later, lower-lid ectropion surgery was performed, combined with tarsectomy to obtain a long-term effect. RESULT: Six months later the lower-lid fornix had stabilized, and the lid and globe had good motility. The corneal lesions had healed. CONCLUSION: The use of 0.1 mm membrane prevents penetration of cell because of the microstructure. Similar to the "bare sclera" technique, which is used in selected cases in strabismus or pterygium surgery, the inner lid and sclera were epithelialized separately from the remaining conjunctiva. The surgical membrane prevented recurrence of the symblepharon. We think the presented technique is an easy, quick method of preventing recurrence of lid fusion after separation of symblepharons.

Penfigoide bolhoso: uma manifestaçao paraneoplasica do cancer de esofago? / Bullous pemphigoid: a para neophasic manifestation of edophageal cancer

E relatado um caso de penfigo bolhoso (PB) associado a carcinoma epidermoide de esofago (CEE). O diagnostico de PB foi elaborado atraves de biopsia e imunofluorescencia direta da pele, enquanto o diagnostico de CCE foi firmado pela endoscopia digestiva e biopsia. A evoluçao da dermatose esteve intimamente relacionada ao tratamento do tumor esofagico (cirurgia e radioterapia), mas a revisao da literatura nao estabelece claramente a relaçao de interdependencia das patologias